convert Obamacare from an imploding, top-down, Washington-centric, mandate-entangled madhouse into something promising: federal dollars that governors and legislators could use to finance bespoke solutions that fit each state’s priorities.

The Republicans have very little leeway on any attempt to craft a new deal on health care. They only have a two-seat majority in the Senate.

“I cannot in good conscience vote for the Graham-Cassidy proposal,” the Arizona Republican said in a statement. “I believe we could do better working together, Republicans and Democrats, and have not yet really tried. Nor could I support it without knowing how much it will cost, how it will (affect) insurance premiums, and how many people will be helped or hurt by it. Without a full CBO score, which won’t be available by the end of the month, we won’t have reliable answers to any of those questions.”

“John McCain was not on the list, so that was an unexpected thing. Terrible. Honestly terrible,” Trump said in Huntsville at an event for Sen. Luther Strange, who faces former judge Roy Moore in a Republican primary Tuesday.

“Republican efforts to repeal and replace Obamacare — derailed just weeks ago — now seem back on track. GOP senators Lindsey Graham of South Carolina, Bill Cassidy M.D., of Louisiana, Dean Heller of Nevada, and Ron Johnson of Wisconsin seek 47 more votes (including, if necessary, that of Vice President Mike Pence, to break a 50–50 tie) to pass their legislation within the Senate’s filibuster-proof reconciliation window. It closes September 30. Having snored through August, Republicans are scrambling to keep the repeal/replacement pledges that secured them the House, Senate, and White House.”

Now that repeal and replace looks likely to fail again the pressure should be on those Republican senators who have opposed all efforts from their party to try and craft a bipartisan agreement before the mid-term elections in the fall of 2018. That could be a difficult path for any Republican to follow. Bernie Sanders has been pushing a single-payer healthcare plan that has been referred to as delusional. The Sanders plan is delusional because it comes with a $32 trillion (yes trillion) price tag over ten years.

There has to be a middle ground of some kind. Americans will not accept single payer because it truly is cost prohibitive. If single payer is all that Democrats can offer they may end up strengthening the Republican majorities in Congress.

Maybe then John McCain, Susan Collins and Lisa Murkowski will get on side with their Republican colleagues. Until then it appears that the third Republican attempt to repeal and replace Obamacare will fail.